Pain
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Randomized Controlled Trial Clinical Trial
Morphine responsiveness, efficacy and tolerability in patients with chronic non-tumor associated pain - results of a double-blind placebo-controlled trial (MONTAS).
Efficacy, long-term effectiveness and safety of opioids in chronic non-tumor associated pain syndromes (NTAS) are still under debate. The study (MONTAS) was performed by physicians and psychologists as a multicenter prospective, randomized, double-blind placebo-controlled crossover trial, followed by an open long-term study. Patients were enrolled only when pain relief from specific defined pretreatment was insufficient. ⋯ Gastrointestinal complaints increased, central nervous system-related complaints were reduced. Efficacy and safety of morphine in NTAS were demonstrated in this randomized-controlled trial. Pretreatment failure was the indication for trying morphine treatment; predictive factors for responsiveness could not be identified.
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Randomized Controlled Trial Clinical Trial
A single infusion of intravenous ketamine improves pain relief in patients with critical limb ischaemia: results of a double blind randomised controlled trial.
We report the first double blind randomised controlled trial of regular opioids and an infusion of low dose (0.6 mg/kg) intravenous ketamine compared with opioids and placebo in patients with allodynia, hyperalgesia and hyperpathia secondary to critical limb ischaemia. Thirty-five patients completed the study, 18 received regular opioids plus ketamine, while 17 received regular opioids plus placebo. Using the Brief Pain Inventory, the % pain relief that the patients in the ketamine group attributed to their medication improved significantly from 50% immediately pre-infusion to 65% 24 h post-infusion and 69% 5 days post infusion. ⋯ This was statistically significant (P<0.05) using both the t-test and the Wilcoxon Rank Sum test. The ketamine group also showed a statistically significant difference 24 h post infusion of the effect of pain on their general activity (P=0.03) and on their enjoyment of life (P=0.004). This study shows that combining a single infusion of low dose ketamine with regular opioid analgesia can result in a significant improvement in pain relief for this patient group.